There are two possible ways to handle charging for surgeons' assistants.
1. Where only the surgeon is participating in AGC
Where the assistant’s and surgeon's services both appear on the same account, the assistant will be paid the AGC benefit, even if they are not participating in the AGC arrangement. Medicare should not reject the claim.
The total amount will be made payable to the surgeon under their provider number. The allocation of the total payment is subsequently decided between the surgeon and the assistant.
2. Where the assistant bills separately
In this case, the assistant must be a participant in the AGC arrangement to receive the AGC benefit. The AGC co-payment will also be available to the assistant when they bill separately. Where the assistant is not registered for AGC, AGC benefits would not be payable.
If the surgeon submits one account with the assistant's services included, to be eligible for AGC the total out-of-pocket gap for the member for the entire account cannot exceed $500. This is because the co-payment rule requires one account per claiming provider - therefore only one co-payment is permissible per claim.